HEALTH

Before 1975 Lebanon boasted advanced health services and medical
institutions that made Beirut a health care center for the entire Middle
East region. The war, however, caused enormous problems. Emergency
medicine and the treatment of traumatic injury overwhelmed the health
care sector during the 1975 Civil War. Indeed, the problems in health
care continued into the 1980s. A World Health Organization (WHO) study
conducted in 1983 found that the private sector dominated health care
services and that public sector health organizations were in chaos. The
weakened Ministry of Public Health maintained little coordination with
other public sector health agencies, and over two-thirds of the
ministry's budget (US$58.5 million in 1982) flowed to the private sector
through inadequately monitored reimbursements for private hospital
services. As of 1983 there were about 3.2 hospital beds (0.23 of them
public) for every 1,000 persons, but control over the quality of
hospital and medical services was minimal, and many public and private
hospital beds were unoccupied. There was about one doctor for every
1,250 inhabitants, but nurses and middle-level technical personnel were
scarce. Furthermore, health personnel were concentrated in Beirut, with
minimum care available in many outlying areas. The Ministry of Public
Health as well as other government and private agencies operated small
clinics and dispensaries, but few such centers existed in Beirut.
Nowhere in Lebanon was there a health center which delivered a full
range of primary health care services.

Although epidemiology is central to public health programs, the WHO
delegation found that government health services in Lebanon lacked
appropriate epidemiological techniques. At the local or community level,
health personnel, especially doctors, rarely reported diseases to the
health department, although they were legally obliged to do so for some
diseases. A similar situation existed with respect to health
establishments such as clinics, dispensaries, and hospitals.
Consequently, not only was there a conspicuous absence of health
records, but where available, they were often incomplete.

Because of the lack of adequate data, only cautious inferences based
on partial data and observations and interviews by the WHO mission can
be made concerning the incidence of disease. Upper respiratory tract
infections and diarrheal diseases headed the list of causes of
morbidity, and infectious diseases were endemic.

Malnutrition was reported to be restricted to groups living in
particularly difficult situations, such as the Palestinian and Lebanese
refugees. Studies on the growth and illness patterns of Lebanese
children, initiated in 1960, indicated 10 percent of children under five
had low weight and height for their age. Various sources reported a high
incidence of mental retardation among children, with cases occurring in
clusters and seemingly related to consanguineous marriages in certain
communities.